Provider Demographics
NPI:1699242438
Name:MATTHEWS, JONATHAN TREVOR (FNP-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TREVOR
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5469
Mailing Address - Country:US
Mailing Address - Phone:903-939-7500
Mailing Address - Fax:903-939-7587
Practice Address - Street 1:8101 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5469
Practice Address - Country:US
Practice Address - Phone:903-939-7500
Practice Address - Fax:903-939-7587
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily